View
215
Download
0
Category
Preview:
Citation preview
TB PUBLIC-PRIVATE MIX DOTS
Dr. Team Bakkhim Deputy Director
CENAT
Intercontinental Hotel7th November, 2012
NATIONAL FORUM ON PUBLIC-PRIVATE PARTNERSHIP IN HEALTH
OUTLINE
Background of TB PPM-DOTS TB PPM-DOTS : Design and implementation Lessons learnt from the success Recommendations
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
1 of 16
BACKGROUND OF THE PROJECT (1)
Cambodia is ranked 21 among the 22 TB high burden countries Approximately two-thirds of all Cambodians are infected with
TB, and around 13,000 Cambodians die annually from the disease
National Tuberculosis Program (NTP) focus on reducing morbidity and death rates due to tuberculosis is a key strategy for improving the overall health of the population
The private sector is accessible, with two thirds of Cambodians seeking care outside the public sector for their first visit with TB symptoms
To align with the WHO Global strategy for TB control (Stop TB Strategy 2006 : engage all care providers )
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
2 of 16
BACKGROUND OF THE PROJECT (2)
In 2004 the NTP began to engage private providers in TB control.
The NTP, with support from their partners, developed the Public-Private Mix (PPM) strategy and it was approved by the Ministry of Health.
During Phase I, with USAID/JICA funds, the NTP and partners designed, implemented, and evaluated a referral network in the private sector where symptomatic individuals seek care and public sector DOTS facilities in pilot provinces
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
3 of 16
Clients suspected TB
Private Clinic / cabinet Private Pharmacy / depot Private Lab.
Public Hospital / Health CenterDiagnosis, Treatment
Recording & Reporting
PHASE I REFERRAL STRATEGY
=
Referral System
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
4 of 16
GOAL FOR TB PPM-DOTS
To test and scale–up a public-private mixed DOTS partnership model that aims to strengthen both the public and private sectors in TB case management and increase case detection
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
5 of 16
SPECIFIC TB PPM-DOTS OBJECTIVES
Reduce diagnostic delay for people with suspected TB, increase case detection, and decrease the opportunity for multi-drug resistance
Strengthen public-private linkages & partnerships in TB case management and control through a referral system to public DOTS services (Phase I)
Improve access to quality DOTS services for people seeking care at the private sector providers by implementing DOTS services in private clinics and hospitals qualified by NTP (Phase II)
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
6 of 16
KEY ACTIVITIES
Develop TB PPM-DOTS strategy Identify and engage private sector partners (Pharmacists
Association of Cambodia (PAC) and Cambodian Medical Association (CMA))
Review and revise national recording and reporting forms Develop standardized referral tools Develop IEC and training curriculums Develop Memorandum of Understanding agreements Organize a sensitization workshop for public and private-public
providers and sign MoU agreements Build capacity for national, PHD, and OD TB staff on PPM and
supervision of private sector Train private providers and DOTS health center staff Conduct quarterly Public-Private Partner meetings Conduct monthly supportive supervision and data collection
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
7 of 16
PPM IMPACT INDICATORS
Number of private providers involved in PPMD. Number of TB suspects referred from the pharmacy to
the DOTS health center Number of TB suspects presenting at DOTS health
center with referral from private providers Number of TB cases identified among TB suspects
referred from private providers.
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
8 of 16
- 2005 : Piloting in : - 3 ODs (2 provinces) (JICA,USAID/PATH, URC)
- 2008 up to now : scaling up : - 37 ODs (10 provinces) (USAID/PATH/TBCARE I /FHI 360/ RHAC, RACHA)
TB PPM sites
ACHIEVEMENT
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
9 of 16
0
200
400
600
800
1000
1200
1400
1600
1800
2005 2006 2007 2008 2009 2010 2011
District
Private
Year 2005 2006 2007 2008 2009 2010 2011
District 3 15 37 37 37 37 37
Private* 287 755 1362 1690 1735 1735 1547
ACHIEVEMENT : PRIVATE PROVIDERS INVOLVED IN TB PPM-DOTS
* Pharmacy, Cabinet/clinic, Laboratory, other
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
10 of 16
0100020003000400050006000700080009000
10000
2005 2007 2009 2011
Referred
Received
TB cases
Year 2005 2006 2007 2008 2009 2010 2011 Total
Referred 314 1989 5562 4212 9781 7612 5024 34494
Received 242 1154 2763 1882 5540 4280 2920 18781(54%)
TB cases 46 224 533 301 769 851 691 3415
ACHIEVEMENT : REFERRED, RECEIVED AND TB CASES
76%
58%
50%45%
57%
57%
58%
There is clear benefit to involving private providers to identify undiagnosed TB cases, to stop selling Anti-TB drugs and prevent MDR-TB
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
11 of 16
LESSONS LEARNT(1)
Factors for success: Strong support from MoH officials and key stakeholders
(USAID, JICA…) Leadership from NTP at all levels (Central, Provincial, OD) Clear task division (MoU) Commitment from all partners (PATH, JICA, URC, RACHA,
RHAC, CATA…) Strong support from professional societies in Cambodia
(CMA, PAC…) High commitment/motivation of private providers at all
levels (Pharmacist, cabinet/clinic,…)
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
12 of 16
Geographic application : Usefulness of PPM-DOTS in less-populated geographic
areas (rural) : Solution applying difficulties (thinly populated, transportation, time, money…)
Recommendations : should be integrated with other projects
Partnerships : Need participation of all private providers Recommendation : Link with other
organizations/institutions (Cambodia Medical Council Committee, Cambodia Pharmacist Council Committee, Cambodia nurse/midwife association…)
LESSONS LEARNT(2)
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
13 of 16
Supportive supervision: Supervision : to ensure that they maintain a high
commitment to their efforts to achieve the TB PPM-DOTS goals.
Recommendations : need regular conscientious supervision of PHD/OD
Regular meetings : The meetings between the key players are critical factor in
the program success and serve several vital functions (opportunity to learn best and receive feedback and new health information)
LESSONS LEARNT(3)
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
14 of 16
Incentives: Private providers, especially pharmacists in Cambodia
participate and support public health programs for reason of merit-offering, professional development and social status.
Recommendations : offering a cash incentive to key players would not threaten program sustainability.
LESSONS LEARNT(4 )
TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT
15 of 16
Recommended